Provider First Line Business Practice Location Address:
80 HUMPHREYS CENTER DR STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-2361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-226-4280
Provider Business Practice Location Address Fax Number:
901-226-4282
Provider Enumeration Date:
04/28/2006